Respiratory Flashcards
Is use of a first generation antihistamine (like Benadryl) disqualifying?
-not always, but must disqualify if it interferes with safe driving
Can a driver who uses continuous supplemental oxygen be qualified under certain circumstances?
No. A driver who needs continuous oxygen has significant underlying dz.
Risk of equipment malfunction can lead to a sudden change in physican and/or mental status.
NOBODY who uses continuous supplemental oxygen can be certified.
When is a driver with active tuberculosis be certified?
-Driver is not contagious and has completed streptomycin therapy without it affecting hearing or balance
-tolerates anti-tubercular therapy well if they haven’t finished the therapy yet
-compliant with drug therapy
-no side effects that interfere with safe driving
-etiologies is confirmed
If a driver with active tuberculosis is certified, for what period of time can you recertify them?
-Can certify for up to two years
-certify on case-by-case basis; get any needed additional medical tests
What makes a driver with active tuberculosis ineligible for certification?
-Driver has advanced TB, resp insufficiency, and cannot meet pulmonary function test criteria
-driver has chronic TB
-noncompliance with tubercular therapy
-has not completed streptomycin therapy
-residual eighth cranial nerve damage affecting balance and/or hearing to an extent that interferes with safe driving
What is important about streptomycin?
-It can cause damage to the eighth cranial nerve and subsequent deficits in hearing and balance
-user streptomycin indicates more severe form of TB
For what period of time can a driver with tuberculosis who is eligible be recertified? What criteria must be met in order for the driver to be recertified?
-Can be certified for up to two years
-certification is on case-by-case basis
What do you do if the driver has a positive PPD test?
-Driver needs a chest x-ray. If it is normal, no further action is required.
-Chest x-ray suggests pulmonary TB findings, further evaluation is needed.
What is atypical tuberculosis?
Same symptoms and range of illness as tuberculosis, but is not contagious
When can a driver with atypical tuberculosis be certified?
-etiology confirmed
-condition stable
-treatment safe and effective
For what period of time can a driver with atypical tuberculosis be certified? What follow-up does this driver need?
-Recertify every two years
-driver needs pulmonary function testing if they have symptoms of extensive pulmonary dysfunction, weakness, fatigue
What would cause a driver with atypical tuberculosis to be disqualified?
Driver has any of the following:
-extensive pulmonary dysfunction
-weakness
-fatigue
-adverse reaction to medical treatment
What is bronchiectasis?
Destruction and widening of large airways
When can a driver with acquired bronchiectasis be certified?
-etiology confirmed
-condition stable
-treatment safe and effective
For what period of time can a driver with acquired bronchiectasis be certified? What follow-up does this driver need?
-Recertify every two years
-driver should take measures to prevent additional infection; for example, should get influenza and pneumococcal vaccines
What would cause a driver with acquired bronchiectasis to be disqualified?
-Temporarily disqualify if driver is experiencing severe infection, or if driver has hemoptysis of volume 250 mL or greater
Suppose a driver may have a chest wall deformity, such as kyphosis scoliosis, kyphosis, massive obesity, pectus excavatum, ankylosing spondylitis, etc. What test must you give to the driver with a chest wall deformity before they can be certified?
-Driver must have near-normal pulmonary function tests to be certified
When can a driver with a chest wall deformity be certified?
When can a driver with a chest wall deformity be certified?
What kind of follow-up does a driver with a chest wall deformity require?
-Must have pulmonary function testing
-if FEV1 < 65% of predicted value, ABG should be obtained
When is a driver with chest wall deformity not eligible to be certified?
-Hypoxemia addressed
-chronic respiratory failure
-history of continuing cough with cost syncope
All smokers over age ____ should have pulmonary function testing done by spirometry.
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When are patients with chronic obstructive lung disease eligible for certification?
-Etiology is confirmed
-treatment safe and effective
-condition does not pose a risk to the safety of the driver and to the public
For what period of time can a patient with chronic obstructive lung disease be certified?
-May be certified for up to two years
For what period of time can a patient with chronic obstructive lung disease be certified?
May be certified for up to two years
What kind of follow-up does a driver with chronic obstructive lung disease require?
-Perform pulmonary function testing
-considerable pulmonary function testing with difficulty breathing at rest
-if FEV1 < 65% of predicted value, ABG should be obtained
When is a driver with chronic obstructive lung disease not eligible to be certified?
-Hypoxemia at rest
-chronic respiratory failure
-continuing cugh with cough syncope
When are patients with a cold eligible for certification?
-Etiology is confirmed
-treatment safe and effective
-condition does not pose a risk to the safety of the driver and to the public
For what period of time can a patient with a cold be certified?
-May be certified for up to two years
What kind of follow-up does a driver with a cold require?
-Perform pulmonary function testing
-considerable pulmonary function testing with difficulty breathing at rest
-if FEV1 < 65% of predicted value, ABG should be obtained
When is a driver with a cold not eligible to be certified?
-Hypoxemia at rest
-chronic respiratory failure
-continuing cugh with cough syncope
When are patients with cystic fibrosis eligible for certification?
-Treatment is safe and effective
-as the medical examiner, you believe the condition doesn’t pose a risk to safety of driver of the public
-driver complies with continuous medical monitoring by a specialist
For what period of time can a patient with cystic fibrosis be certified?
-may certify for maximum of two years, but if driver needs frequent monitoring, then certify for one year
What kind of follow-up does a driver with cystic fibrosis require?
-May certify for two years maximum, but for only one year if driver needs frequent monitoring
-if FEV1 < 65% of predicted value, ABG should be obtained
When is a driver with cystic fibrosis not eligible to be certified?
-Hypoxemia at rest
-chronic respiratory failure
-history continuing cough with cough syncope
-spirometry parameters are not met
-unstable condition
-unstable treatment regimen
When are patients with interstitial lung disease eligible for certification?
-etiology confirmed
-Treatment is safe and effective
-as the medical examiner, you believe the condition doesn’t pose a risk to safety of driver of the public
For what period of time can a patient with interstitial lung disease be certified?
-Maximum of two years
What kind of follow-up does a driver with interstitial lung disease require?
-Two year maximum certification
-get additional studies if x-ray shows extensive abnormalities and/or dyspnea
-perform PFTs to follow guidelines listed in additional pulmonary function tests sections
- if FEV1 < 65% of predicted value, ABG should be obtained
When is a driver with interstitial lung disease not eligible to be certified?
-Hypoxemia addressed
-chronic respiratory failure
-history of continuing cough with cough syncope
When are patients with pneumothorax eligible for certification?
-check chest x-ray to ensure complete resolution of the pneumothorax; if there is air in the pleural space or there is pneumomediastinum, additional time away from work is needed
-driver must be asymptomatic without chest pain or dyspnea
-no disqualifying underlying lung disease
-confirmed resolution of the single spontaneous pneumothorax
-successful pleurodesis and meets acceptable pulmonary parameters
For what period of time can a patient with pneumothorax be certified?
Maximum of two years
What kind of follow-up does a driver with pneumothorax require?
-Two-year max certification
-chest x-ray required
When is a driver with pneumothorax not eligible to be certified?
-History of two or more spontaneous pneumothorax sees on one side, if driver has not had a successful surgical procedure to prevent recurrence
-hypoxemia at rest
-chronic respiratory failure
-history of continuing cough with cough syncope
Allergic rhinitis is rarely severe enough to limit ______ .
-certification
-best treated with non-sedating antihistamines or by using local steroid sprays that don’t interfere with driving ability
When are patients with allergic rhinitis eligible for certification?
-Etiology is confirmed
-treatment safe and effective
-condition does not pose a risk to the safety of the driver and to the public
For what period of time can a patient with a allergic rhinitis be certified?
-May be certified for up to two years
-on case-by-case basis, obtain additional tests
When is a driver with allergic rhinitis not eligible to be certified?
-when there are complications and/or treatments that may impair ability to operate a commercial motor vehicle safely
-severe conjunctivitis affecting vision
-inability to keep eyes open
-photophobia
-uncontrollable sneezing fits
-sinusitis with severe headache
-medications cause sedation or other side effects that interfere with safe driving
When can a driver with a history of anaphylaxis or life-threatening angioedema be certified?
-When successful measures to prevent adverse effects are implemented
-when you is a medical examiner believe the condition does not pose a risk to the driver in the public
For what period of time can a patient with a history of anaphylaxis or life-threatening angioedema be certified?
-Two your maximum certification
-on a case-by-case basis, may obtain additional medical tests
When is a driver with a history of anaphylaxis or life-threatening angioedema not eligible to be certified?
-No effective treatment regimen in place
-no successful prevention measures
For what period of time can a patient with a history of asthma be certified?
-Two year maximum certification
-on case-by-case basis, obtain additional tests
When is a driver with a history of asthma not eligible to be certified?
-Continual, uncontrolled, symptomatic asthma
-significant impairment of pulmonary function:
* FEV1 < 65%
* significant hypoxemia, showing up as partial pressure of arterial oxygen less than 65 mmHg
When can a driver with a history of hypersensitivity pneumonitis be certified?
-Successful measures to prevent adverse effects are implemented
-you, as a medical examiner, believe the condition does not pose a risk to the driver in the public
For what period of time can a patient with a history of hypersensitivity pneumonitis be certified?
-May certify for maximum of two years
What follow-up care is needed for a driver with a history of hypersensitivity pneumonitis?
-on case-by-case basis, get additional tests
-needs continual medical oversight
-to alleviate symptoms driver must avoid exposure to the causative agent
When is a driver with a history of hypersensitivity pneumonitis not eligible to be certified?
-You believe the nature and severity of the drivers medical condition endangers the health and safety of the driver and the public
If you suspect a driver has obstructive sleep apnea, what is the next step? Can this driver have certification?
-Order a sleep study
-limited certification to keep the driver working until the sleep study is performed is appropriate
-this is a discretionary standard
-FMCSA recommendations for surgery or CPAP usage should be followed
What are parameters that should be evaluated when considering certification intervals for drivers with obstructive sleep apnea?
body mass index, neck circumference, and comorbidities are a few of the parameters
When can a driver with a history of obstructive sleep apnea be certified?
-Waiting period of one month after starting CPAP, if successful and compliant
-waiting period of three months after surgical correction with resolution of symptoms
-driver can also qualify if they have successful nonsurgical therapy with multiple sleep latency tests in the normal range or resolution compared confirmed by repeated sleep study
For what period of time can a patient with a history of obstructive sleep apnea be certified?
One year maximum certification
What follow-up care is needed for a driver with a history of obstructive sleep apnea?
-Driver must remain symptom-free
-driver must continue uninterrupted therapy and undergo yearly objective testing
When is a driver with a history of obstructive sleep apnea not eligible to be certified?
-Hypoxemia at rest
any of the following chronic sleep disorder diagnoses disqualify a driver from certification:
* untreated symptomatic obstructive sleep apnea
* narcolepsy
* primary idiopathic alveolar hypoventilation syndrome
* idiopathic central nervous system hyper somnolence
* restless leg syndrome associated with excessive daytime sleepiness
When a driver has excessive daytime sleepiness with unknown etiology, you can order an objective sleep test to determine the presence of a sleep disorder. You should consult with the drivers employer when making these final decisions. What are the names of some tests you might consider?
-polysomnography in controlled sleep lab
-napping tests:
* maintenance of wakefulness
* multiple sleep latency
Describe the maintenance of wakefulness test. What is its purpose?
-Four sleep trials
-patient tries to stay awake as long as possible
Purpose: assess potential risk for work related injury in those with sleep disorders
Describe the multiple sleep latency test. What is its purpose?
“nap study”
evaluates number of REM cycles and speed of falling asleep
Purpose: assess diagnosed severity of narcolepsy or idiopathic hypersomnia
Describe the polysomnogram test. What is its purpose?
-Charts brain waves, oxygen saturation, vital signs, sleep cycle during sleep
Purpose: diagnose sleep apnea and other sleep-related breathing disorders
Apnea is defined as occurring when respirations cease for more than _________ seconds.
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Hypopnea occurs when air flow decreases during respirations for more than _______ seconds.
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The apnea-hypopnea index is a way to try to describe severity of apnea and hypopnea that affect a driver who has a sleep disorder. What does it mean to say that the driver has a mild apnea-hypopnea index?
Patient has between 5 and 14 episodes of apnea or hypopnea per hour.
What does it mean to say that the driver has a moderate apnea-hypopnea index?
Patient has between 15 and 29 episodes of apnea or hypopnea per hour.
What does it mean to say that the driver has a severe apnea-hypopnea index?
Patient has 30 or more episodes of apnea or hypopnea per hour. Patients in this range meet criteria for being diagnosed with obstructive sleep apnea.
What is cor pulmonale?
Secondary enlargement of the right ventricle caused by respiratory or cardiovascular disorders that affect the structure or function of the lungs.
What is the most common respiratory cause of cor pulmonale?
hypoxic pulmonary vasoconstriction in patients who have chronic obstructive lung disease
With the most common cardiovascular cause of cor pulmonale?
Pulmonary hypertension caused by heart failure
What are common symptoms of patient with cor pulmonale might have that can affect driving?
Dizziness
Hypertension
Syncope
side effects of vasodilators
When can a driver with a history of cor pulmonale be certified?
-diagnosis is confirmed and treatment has been shown to be safe and effective
-you don’t feel that the cor pulmonale or its underlying cause doesn’t affect safety of the driver or public safety
For what period of time can a patient with a history of cor pulmonale be certified?
-two year max certification
-if you feel the driver need frequent monitoring, then certify for one yr or less
What follow-up care is needed for a driver with a history of cor pulmonale?
-if driver has dyspnea at rest, order addt’l testing such as PFTs
- if FEV1 < 65% of predicted value, ABG should be obtained
When is a driver with a history of cor pulmonale not eligible to be certified?
-you feel that the cor pulmonale or its underlying cause affects safety of the driver or public safety
-dyspnea at rest
-dizziness
-hypotension
- partial pressure of arterial oxygen less than 65 mmHg
What is pulmonary HTN?
-condition in which pulmonary artery pressure is > 50% of systemic systolic blood pressure, regardless of the cause
-may occur with or without cor pulmonale
-is associated with increased risk for sudden incapacitation, whether primary or secondary pulmonary hypertension
When can a driver with a history of pulmonary hypertension be certified?
-diagnosis confirmed
-treatment has shown to be safe and effective
-you feel the pulmonary hypertension or its underlying cause does not affect driver safety and safety of the public
For what period of time can a patient with a history of pulmonary hypertension be certified?
-One year maximum certification
-determine on a case by case whether patient needs consultation
When is a driver with a history of pulmonary hypertension not eligible to be certified?
